论文部分内容阅读
目的回顾分析疑难部位肝脏占位切除手术的手术经验、手术风险、并发症及处理。方法根据肿瘤邻近位置将47例患者分为第一肝门组、第二肝门组和尾状叶组,所有患者均行肝部分切除术。结果平均手术时间(289.6±62.2)min,平均出血量(602.3±256.4)ml,术中平均输血量(524.0±325.9)ml。3组患者的手术并发症发生率分别为61.5%、26.9%和25%。严重手术并发症为胆漏(27.7%)、出血(6.4%)和术后肝功能衰竭(2.1%)。3例围手术期死亡,原因分别为出血2例、肝功能衰竭1例。结论疑难部位肝脏占位手术中肝脏的游离和重要血管和胆管的显露非常关键,切除肿瘤过程中精细处理肝内的微小管道可以明显减少术后并发症。术前综合评估对判断手术可行性、预测手术风险非常重要,一旦损伤肿瘤邻近的重要血管,不仅导致出血,而且常因为流出道或流入道的梗阻导致相应的肝叶坏死,第二肝门血管的损伤比第一肝门损伤更具致死性。
Objective To retrospectively analyze the surgical experience, surgical risk, complications and management of difficult place liver space excision. Methods 47 patients were divided into the first hepatic portal group, the second hepatic portal group and the caudate lobe group according to the tumor adjacent position. All patients underwent partial hepatectomy. Results The average operation time (289.6 ± 62.2) min, the average amount of bleeding (602.3 ± 256.4) ml and the mean intraoperative blood transfusion (524.0 ± 325.9) ml. The incidence of surgical complications in the three groups was 61.5%, 26.9% and 25%, respectively. Serious surgical complications included bile leakage (27.7%), bleeding (6.4%) and postoperative liver failure (2.1%). Perioperative deaths occurred in 3 cases, with 2 cases of hemorrhage and 1 case of liver failure. Conclusion It is very important for the liver to be free and to reveal the important blood vessels and bile ducts in the difficult parts of the liver space occupying surgery. The delicate treatment of tiny tubes in the liver during tumor resection can significantly reduce the postoperative complications. Comprehensive assessment of the preoperative evaluation of the feasibility of surgery to predict surgical risk is very important, once the damage adjacent to the important blood vessels, not only lead to bleeding, and often due to obstruction of the outflow tract or inflow tract lead to the corresponding lobar necrosis, the second hepatic vessels Of the lesions are more lethal than the first hepatic portal lesion.